Why Is It So Hard to Get a Lyme Disease Diagnosis?

 

Photo: Getty Images

Avril Lavigne opened up again this week about her struggle with Lyme disease, a tick-borne illness she says left her bedridden for months and desperate for answers. The 30-year-old singer told Good Morning America this week that she saw many doctors and underwent a battery of tests in the last year, but that it wasn’t until she found a Lyme disease specialist that she was given a correct diagnosis.

“I was in Los Angeles, literally, like the worst time in my life and I was seeing, like, every specialist and literally, the top doctors. It’s so stupid,” Lavigne said in an interview televised yesterday. She says that some misdiagnosed her symptoms—debilitating pain and fatigue—as chronic fatigue syndrome or depression, while others told her she was simply dehydrated or exhausted from touring.

“This is what they do to a lot of people who have Lyme disease,” she said. “They don’t have an answer for them so they tell them, like, ‘You’re crazy.'”

Lavigne began to suspect she had Lyme disease—the number-one insect-borne disease in the United States—a few months after she began feeling exhausted and lightheaded. Her symptoms eventually got so bad she felt like she couldn’t breathe, talk, or move. “I thought I was dying,” she told People in April.

RELATED: 15 Diseases Doctors Often Get Wrong

So why did it take so long for Lavigne to get answers? And could her experience happen to others, as well?

Fortunately, most cases of Lyme disease are caught and treated much earlier, says Anne R. Bass, MD, a rheumatologist at the Hospital for Special Surgery in New York City, and this degree of misdiagnosis isn’t very common. But pinpointing this type of infection is not an exact science, and symptoms are not always crystal clear.

“Many people will develop a bulls-eye rash, which makes it fairly easy to diagnose,” she says. But this telltale symptoms is sometimes faint or on hidden parts of the body, and some people don’t get one at all.

“Other early symptoms, like fever or aches and pains, could be attributed to a virus or flu,” says Bass. “So if you don’t see a rash, you might not even go to the doctor—or it’s possible your doctor might not recognize it.” (Some Lyme disease cases go away on their own, she adds, so it’s possible to have had it and never known.)

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Most physicians, especially those who practice in tick hot-spots like the northeastern United States, know to look out for Lyme disease symptoms during spring and summer months. But the disease is less prevalent in Southern California, where Lavigne says she was seeking treatment. If a patient hasn’t had a rash and doesn’t remember being bitten, doctors there may be slower to identify ticks as a potential factor.

Bass says that anyone who’s experienced fatigue or joint pain for several months should think back to when their symptoms started, and whether they spent time in area of the country known for Lyme disease outbreaks. A blood test cannot confirm whether you are currently infected, but it can tell if you have been exposed to Lyme bacterium in the past. (It actually tests for antibodies, which develop a few weeks after a person has been infected and remain in the blood forever.) Doctors can use these test results, along with a person’s current symptoms, to make a diagnosis.

“But even these test results can be complex and confusing, especially for physicians who aren’t used to dealing with Lyme,” Dr. Bass says. Some doctors also believe that Lyme disease can be diagnosed without a positive blood test, she adds—although there’s no evidence that these methods are accurate or that antibiotics, in these cases, work any better than placebo.

RELATED: The Latest on Lyme Disease

(Lavigne did not reveal exactly how she was diagnosed or whether she tested positive for Lyme antibodies, although she did say she had blood tests when she first became ill.)

Once Lyme disease is diagnosed, two to three weeks of oral antibiotics usually help patients feel better and eliminate all symptoms. If it goes untreated for several months, however, a longer course of drugs—usually four weeks—is often needed. In extreme cases, antibiotics may also be given through an IV.

Bass says that it’s uncommon for patients to be prescribed antibiotics for more than a month, even if they continue to experience fatigue and pain. “It does take longer for them to get better when there is a delay in diagnosis, but it doesn’t really change our duration or course of treatment,” she says. “They may just need to rest and take it easy a bit longer until they have their energy back.”

RELATED: 10 States Where Rare and Exotic Diseases Lurk

Lavigne is finally feeling better, and says she expects to make a full recovery. That’s a good thing, since 10 to 20 percent of people with Lyme disease continue to experience symptoms for months or even years after treatment. This condition is sometimes called chronic Lyme disease, although it’s technically known as post-treatment Lyme disease syndrome.

Doctors aren’t sure what causes post-Lyme syndrome (some believe that symptoms are due to other tick-borne illnesses, or to chronic conditions like rheumatoid arthritis), and treatments like long-term antibiotic therapy are controversial. But a recent study from Johns Hopkins University showed that one thing is clear: Prolonged Lyme-related illness is more common than was once believed.

“Our data show that many people who have been diagnosed with Lyme disease are in fact going back to the doctor complaining of persistent symptoms, getting multiple tests, and being retreated,” the study authors said in a news release. “It is clear that we need effective, cost-effective, and compassionate management of these patients to improve their outcomes, even if we don’t know what to call the disease.”

RELATED: What You Should Do If You Find a Tick

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The Strange Link Between Junk Food and Depression

Photo: Getty Images

Of our many modern diseases, one of the biggest burdens on society is an unexpected one: depression, according to the World Health Organization. And what we eat may be contributing, finds a new study published in the American Journal of Clinical Nutrition.

James E. Gangwisch, PhD, assistant professor at Columbia University in the department of psychiatry, wanted to find out whether foods with a higher glycemic index (GI)—a scale that ranks carbohydrate-containing foods by how much they raise your blood sugar—would be associated with greater odds of depression. “When I was a kid, I was almost like a candy junkie,” Gangwisch says. “I noticed for myself, if I eat a lot of sugar, it makes me feel down the next day.” Gangwisch says he stopped eating added sugar years ago but remained curious about whether a junk food diet could make people depressed.

He and a team of researchers looked at data from food questionnaires and a scale that measures symptoms of depressive disorders from postmenopausal women in the Women’s Health Initiative Observational Study. The data came from roughly 70,000 women, none of whom suffered from depression at the study’s start, who had baseline measurements taken between 1994 and 1998, and then again after a three-year follow-up.

Diets higher on the glycemic index, including those rich in refined grains and added sugar, were associated with greater odds of depression, the researchers found. But some aspects of diet had protective effects against developing depression, including fiber, whole grains, whole fruits, vegetables and lactose, a sugar that comes from dairy products and milk that sits low on the glycemic index.

Added sugars—but not total sugars or total carbohydrates—were strongly associated with depression.

Though the authors couldn’t pinpoint a mechanism from this study—it was associative—they note that one possibility is that the overconsumption of sugars and refined starches is a risk factor for inflammation and cardiovascular disease, both of which have been linked to the development of depression.This kind of diet could also lead insulin resistance, which has been linked to cognitive deficits similar to those found in people with major depression.

Further research is needed, Gangwisch says, and it’s not yet known whether the results would translate to a broader group of people, including men and younger women. But even now, diet may be worth discussing with people who suffer from depression, Gangwisch says—even though doing so may be difficult. “It’s hard enough to get the general public to avoid those kinds of foods, but it’s even harder to get someone who suffers from depression to avoid them and give them up,” he says. “You don’t want people to feel guilty either…to say, ‘Your diet’s bad and you should change it,’ would take kind of a soft sell approach.” Still, he believes the effort is worth it. “I think it’s important and I think it has a big effect on your mood and how you feel and your energy level,” he says. “If it’s something that people can change, they really would benefit from it.”

This article originally appeared on Time.com.

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Umbilical Cord ‘Milking’ May Help Preemies Delivered by C-Section

TUESDAY, June 30, 2015 (HealthDay News) —
Gently massaging the umbilical cords of preterm infants delivered by C-section may improve their blood pressure, boost blood flow and increase levels of red blood cells, a new study finds.

Researchers suggest this technique could offer these preemies greater health benefits than the current method of delaying cord clamping for up to one minute after delivery.

“The study results are very encouraging,” Dr. Tonse Raju, chief of The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Pregnancy and Perinatology Branch, said in an agency news release. “The findings need to be confirmed in a larger number of births, but at this point, it appears that umbilical cord milking may prove to be of great benefit to preterm infants delivered via cesarean.”

The study involved 197 infants born at or before 32 weeks. Of these infants, 154 were delivered via C-section. Researchers at the Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns in San Diego and Loma Linda University in California divided the babies into two groups and randomly assigned them to receive either delayed cord clamping or umbilical cord milking.

Cord milking involves massaging the umbilical cord with the thumb and forefingers to slowly push blood through the cord into an infant’s belly. This technique increases blood flow from the cord into an infant’s circulatory system.

The 43 infants delivered vaginally were also randomly assigned to receive either delayed clamping or cord milking.

Among the preterm babies born via C-section, those in the cord milking group had greater blood flow between the brain and the heart. These babies also had increased blood flow from their heart, and higher blood pressure and more red blood cells, the study published online June 29 in the journal Pediatrics revealed.

But cord milking was no more beneficial than delayed cord clamping among preterm infants born vaginally.

In 2012, the American College of Obstetricians and Gynecologists recommended a 30- to 60-second delay before clamping the umbilical cord in all preterm deliveries. This is supposed to allow blood from the umbilical cord to fill the blood vessels in the infant’s lungs, Raju said. It can help prevent bleeding in the brain among preterm infants, which can cause developmental delays, cerebral palsy or even death.

Some studies, however, show delayed cord clamping doesn’t reduce bleeding among some preterm infants delivered by C-section. Anesthetics used during these deliveries eases contractions of the uterus, which may prevent blood from flowing from the umbilical cord, the researchers explained.

Cord milking could help offset this reduced blood flow and increase infants’ blood volume, they noted.

More information

The March of Dimes provides more information on premature babies.

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Too Few Men With Low-Risk Prostate Cancers Get ‘Watch and Wait’ Approach

By Randy Dotinga
HealthDay Reporter

TUESDAY, June 30, 2015 (HealthDay News) — A wide majority of U.S. men with low-risk prostate cancer are being treated for the disease even though “active surveillance” is an option, a new report finds.

Active surveillance — or watchful waiting — is the careful monitoring of prostate cancer for progression of the cancer that would indicate a need for treatment. Men in the Northeast and on the West Coast were especially likely to have active surveillance rather than cancer treatment, potentially sparing them from complications associated with treatment.

The study data was collected in 2010 and 2011, and a lot has changed since that time in regard to the popularity of active surveillance, experts noted.

Active surveillance is “gaining acceptance among urologists and patients,” said study co-author Dr. Hui Zhu, chief of urology at the Louis Stokes Cleveland VA Medical Center in Ohio.

“Age-appropriate men should discuss the risks and benefits of screening with their physicians, and men with newly diagnosed localized prostate cancer should ask their physicians whether active surveillance is a good option for them,” he added.

There’s been controversy for years about diagnosing and treating prostate cancer. Tumors considered to be low-risk may never spread, but men have often been treated anyway. But, those treatments aren’t without risk. Prostate cancer treatments can cause serious and lasting side effects, such as incontinence and erectile dysfunction, according to the American Cancer Society.

In 2011, the U.S. Preventive Services Task Force discouraged the use of routine prostate cancer testing. One reason why was because of the odds that low-risk tumors would be treated. But, despite that recommendation, many doctors continue ordering the prostate-specific antigen (PSA) tests. Supporters of the test suggest that if the PSA leads to an overdiagnosis of low-risk prostate cancers, that problem can be countered with active surveillance, the study authors noted.

The new report examines a national database that includes about 70 percent of cancer cases in the country.

Of nearly 190,000 mean diagnosed with prostate cancer, between 11 percent and 40 percent would be considered low-risk enough to be eligible for watch-and-wait approach. (There isn’t a consensus about which patients should consider this strategy, and the report looks at different cut-off points.) Of those men, just 7 percent to 12 percent had active surveillance, the study revealed.

Older men — those over 60 — were more likely to have active surveillance. Men without insurance were also more likely to have active surveillance, the study said.

The researchers found that watchful waiting was most common on the West Coast and in the Northeast. The states with the lowest levels — under 5 percent — were Alabama, Mississippi, Tennessee and Kentucky.

Dr. Stephen Freedland, a urologist and director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute in Los Angeles, pointed out that the report’s data is outdated. The situation has “changed dramatically” over the past few years, with early research suggesting that many more men are choosing the surveillance option.

Before, he said, doctors chose treatment instead of monitoring because they weren’t comfortable with watchful waiting and “didn’t fully appreciate how well the patients do; how safe it is to do that.”

He said it’s rare for patients to simply never come back after being diagnosed.

Also, he said, “there was no imperative, no push to do it. It’s a counterintuitive thing to say ‘You have cancer, but I’m not going to do anything.'”

So, where does that leave men with low-risk prostate cancers?

“Prostate cancer, even the lethal form, is highly treatable when it is detected at an early stage through the use of screening,” Zhu said.

“Men aged 55 to 69 years who are considering being screened for prostate cancer should have a discussion with their physicians which involves weighing the benefits of preventing death from prostate cancer against the known potential harms associated with screening and treatment,” Zhu added.

The report was published online June 29 in the journal JAMA Internal Medicine.

More information

For more about prostate cancer, try the American Cancer Society.

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Make CPR, Defibrillator Training Mandatory for High School Graduation: Experts

TUESDAY, June 30, 2015 (HealthDay News) — Far too few Americans are surviving cardiac arrest, and a new report issued Tuesday by a federally appointed panel of experts sets out ways to boost survival rates.

One recommendation: Make a working knowledge of CPR and the use of an automated electronic defibrillator (AED) a graduation requirement for all middle- and high-school students.

One expert in emergency care applauded the proposal.

“By teaching laypersons in public settings the proper use of such devices, we may be able to effectively increase survival rates from out-of-hospital cardiac arrest,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

According to the new Institute of Medicine (IOM) report, less than 6 percent of the 395,000 Americans who suffer cardiac arrest outside a hospital each year will survive.

And even in a hospital setting, cardiac arrest survival rates are low, the independent panel said. Roughly 200,000 events occur each year in hospitals but just 24 percent of those patients survive.

“Although breakthroughs in understanding and treating cardiac arrest are promising, the ability to deliver timely interventions and high-quality care is inconsistent,” Robert Graham, chair of the study committee, said in a news release from the National Academy of Sciences (NAS), which oversees the Institute of Medicine.

“Cardiac arrest treatment is a community issue, requiring a wide range of people to be prepared to act,” said Graham, who directs the national program office for Aligning Forces for Quality at George Washington University, in Washington, D.C. Those who can help include “bystanders, family members, first responders, emergency medical personnel, and health care providers,” he said.

Cardiac arrest is not the same thing as a heart attack, according to the NAS. A heart attack occurs when blood flow to the heart is blocked due to narrow or clogged arteries. Heart attacks damage the heart muscle and can cause symptoms like pain, dizziness and trouble breathing.

In contrast, cardiac arrest occurs when an interruption to the heart’s electrical activity causes it to stop beating. A heart attack can lead to cardiac arrest, as can certain genetic mutations or severe electrolyte imbalances.

People who suffer cardiac arrest almost immediately lose consciousness, the NAS said. Their circulation and their heart’s electrical rhythm must be restored as soon as possible.

So, why is cardiac arrest survival so low in the United States?

According to the IOM report, survival depends on several factors, including where cardiac arrests occur, if there are witnesses nearby who are prepared to intervene and what resources are available to deliver timely and effective treatment.

All of these variables could be improved, the IOM panel said, and it offered up key actions that might help save lives:

• Monitor performance and track progress through a national registry of cardiac arrests, which could help health officials spot problems.
• Better educate the public on how to spot cardiac arrest, contact emergency responders, perform CPR and use an AED. The committee supports CPR and AED training as graduation requirements for all middle- and high-school students.
• Improve the performance of EMS systems, focusing on dispatcher-assisted CPR and high-performance CPR.
• Develop strategies to boost care within hospitals, including setting national cardiac arrest accreditation standards. Adopt “continuous quality improvement programs” for cardiac arrest to encourage training within hospitals.
• Promote the development of new, potentially lifesaving technologies and expand research in cardiac arrest resuscitation.
• Create a “national cardiac arrest collaborative,” to identify common goals.

These goals are based largely on the fact that following a cardiac arrest, each minute without treatment decreases the likelihood that patients will survive without disability.

The IOM notes that cutting the time that lapses between cardiac arrest and the initiation of chest compressions is essential. For every minute that passes after a person suffers a cardiac arrest and circulation is restored, the likelihood of their survival drops by 10 percent.

More than eight out of 10 cardiac arrests occur at home. Of these, 45 percent are witnessed by another person. For such event taking place outside a hospital setting at 10 different locations in North America, research shows survival rates range from more than 7 percent to almost 40 percent. Risk-adjusted survival rates for cardiac arrests that occur in the hospital also vary by about 10 percent between the lowest and best performing hospitals.

Right now, CPR training among Americans is low — less than 3 percent of the U.S. population receives such training each year, leaving them unprepared to help in the event of an emergency, the IOM noted.

Glatter believes that emerging technologies may hold the key to saving more lives.

For example, “the use of text messaging which can alert EMS systems as well as all nearby bystanders to an arrest may provide another method to activate a team-based approach to cardiac arrest in the field,” he said. Someday, robotic drones might even be used to quickly dispatch an AED to the site of a cardiac arrest, Glatter said.

Dr. Evan Herzog directs the cardiac care unit at Mount Sinai St. Luke’s Hospital in New York City. “”I absolutely agree with the IOM’s new recommendations to help increase the survival of cardiac arrest victims,” he said. “The time to take greater action to save more lives is now.”

More information

The American Heart Association provides more information on the cardiac arrest.

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Cystic Fibrosis Might Be Deadlier for Hispanics, Study Suggests

TUESDAY, June 30, 2015 (HealthDay News) — Cystic fibrosis is deadlier for Hispanic patients than others, and genetic differences may make Hispanics less likely to benefit from new treatments for the disease, researchers report.

“We need to ask if the care model for patients with [cystic fibrosis] is working for this minority group,” study author Dr. MyMy Buu, an instructor in pediatric pulmonary medicine at Stanford University School of Medicine in Palo Alto, Calif., said in a university news release. “We want to make sure that what we are doing is not inadvertently causing disparities.”

The findings reflect an urgent need to identify the factors that contribute to this health disparity, the researchers noted.

“This will be crucial to develop treatment regimens that guarantee that all children with [cystic fibrosis] can benefit from early diagnosis and the novel treatments being introduced,” study co-senior author, Dr. Carlos Milla, director of the Stanford Cystic Fibrosis Center, said in the news release.

Cystic fibrosis is a genetic disease that causes serious lung and digestive problems. Using patient data from the patient registry of the Cystic Fibrosis Foundation, researchers examined all California residents diagnosed with the disease as children between 1991 and 2010. Overall, more than 1,700 patients were included in the study; 28 percent were Hispanic.

During the study, 9 percent of the Hispanic patients died, compared to slightly more than 3 percent of non-Hispanic patients, according to the study published online recently in the journal Chest. The risk for death was nearly three times greater for Hispanic patients, the researchers noted.

Some plausible explanations were ruled out, including later diagnosis and less access to health care.

The only key differences the researchers found between the two groups was that Hispanics developed cystic fibrosis complications earlier and tended to have less common mutations in their disease-causing gene, known as the CFTR gene.

“We are moving in the direction of gene mutation-directed therapy,” Buu said. “The [cystic fibrosis] research community is trying to understand these mutations, and those that are most frequent in the [cystic fibrosis] population are being studied first.”

In the past, most cystic fibrosis patients died during childhood, but dramatically improved treatments have improved survival rates. More than half of all cystic fibrosis patients in the United States now live beyond 40, the researchers said.

When it comes to current treatments, however, Hispanic patients with rare mutations are at a disadvantage. “It will take longer to get to them, but there are efforts to understand all the mutations of the CFTR gene,” said Buu. “We hope to create awareness of this disparity, and we hope that it is modifiable.”

More information

The U.S. National Heart, Lung, and Blood Institute provides more information on cystic fibrosis.

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Americans Want Online Access to Doctors, Health Records: Survey

TUESDAY, June 30, 2015 (HealthDay News) — Internet-savvy Americans would like to add their doctors to their group of Facebook “friends” or email contacts.

In a new study, researchers analyzed more than 2,250 responses from a national survey of retail pharmacy customers.

Many of those surveyed were frequent Facebook users who wanted to be able to contact their doctor about health-related matters through this social networking site or via email.

Thirty-seven percent of participants said they’d emailed their doctor in the past six months, and 18 percent had reached out through Facebook. The researchers said this was surprising since most medical centers discourage social media contact between doctors and patients due to privacy issues and legal concerns.

Those most likely to reach out to their doctor electronically are non-whites, people younger than 45 and those with higher incomes, according to the study recently published in the Journal of General Internal Medicine.

Caregivers and patients with chronic illnesses are also more likely to use email or Facebook to communicate with their doctor. People with less education and lower incomes were less likely to reach out to their doctor online, the findings showed.

Accessing health information electronically is also preferred, survey results revealed. Up to 57 percent of respondents reported wanting to use their doctors’ websites for this purpose. About 46 percent also wanted to track their health progress or access health information through email.

Electronic health records have made these options available to patients at many hospitals, but few patients actually use them. Only 7 percent of those polled ever access their own heath information on their doctors’ website and only 7 percent order drugs by email, the survey showed. This suggests patients may not know about the online health services available to them, the study authors suggested.

“The findings highlight the gap between patient interest for online communication and what physicians may currently provide,” study author Joy Lee, of Johns Hopkins Bloomberg School of Public Health in Baltimore, said in a journal news release.

“Improving and accelerating the adoption of secure web-messaging systems is a possible solution that addresses both institutional concerns and patient demand,” Lee said.

More information

The U.S. Department of Health and Human Services has more on ways to improve communication between patients and doctors.

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American Marriages Are Much Better — and Much Worse — Than Ever

The Newlywed Game. Photo: ABC Photo Archives/Getty Images

When your partner is your best friend — someone who really gets you, you know? — it’s a wonderful thing. And yet thinking of marriage as the ultimate BFF-ship potentially comes with its own set of problems, setting some lofty expectations for the relationship. It often means that this is the one person to whom you look to meet your deepest psychological and personal growth requirements; it’s the tippy-top of the old Maslow’s Hierarchy of Needs pyramid, in other words.

When it works, it’s bliss. But according to the authors of a new paper in Current Directions in Psychological Science — lead-authored by Northwestern University’s Eli Finkel — it’s also incredibly difficult to meet these huge and time-consuming demands, meaning the modern American marriage has the potential to be both much better and much worse than ever before. Because here’s the twist: At the same time Americans are asking more out of their marriages than ever, they’re also spending less time with their spouses. 

Modern American marriages are more strongly linked to psychological well-being — happiness, basically — than they were in decades past, according to a review of 93 studies from 1980 to 2005, and the authors on this current paper, led by Northwestern University’s Eli Finkel, believe they know why. Basically, they think Americans have begun understanding their marriages in a different, historically unusual way than they used to.

To Finkel and his co-authors, there have been three major eras of marriage in American history, cultural shifts in what’s largely considered the fundamental purpose of the institution. In the country’s earliest years, marriage was there to help people meet basic economic needs — someone to help harvest the crops and keep warm in the winter. Then there was a middle era, from about 1850 to 1965, when employment shifted to outside the home, and the point of marriage was to be a source for love and passion.

Today, Finkel and his colleagues argue, it’s a “self-expressive era” of marriage, in which Americans look to the institution “to fulfill needs like self-esteem, self-expression and personal growth.” Finkel expanded on that in an email to Science of Us:

As we have increasingly come to look to our marriages to help us achieve our deepest psychological needs—rather than helping us harvest crops or even just loving us, for example—we need much stronger communication and responsiveness than ever before. More and more marriages are struggling to achieve those lofty standards, especially on top of all of the other stresses in our lives.

However, those of us who succeed in building a marriage that can meet our deepest psychological needs—a marriage that helps us become closer to our ideal self—are immensely satisfying. That is, achieving a successful marriage today is tougher than in the past, while at the same time the payoff for such achievement is larger than in the past.

Helping your partner harvest crops or weather a drought or prepare for winter wasn’t easy, in other words, but these things also didn’t require deep contemplation and understanding of his or her innermost thoughts and desires. Meeting these self-actualization expectations takes some serious face time together, and yet the evidence shows that at the same time Americans are demanding more out of their marriages, they’re also putting less time into them.

To wit, as Finkel and his co-authors point out: From 1975 to 2003, the amount of times childless couples spent together, just the two of them, dropped from 35 to 26 hours per week. The decline in togetherness-time is most likely explained by a rise in time spent working. During that same time period, couples with kids saw a similar dip in time spent one-on-one, from 13 to 9 hours per week. This decline appears to be owed to an uptick in what the researchers called “time-intensive parenting.” 

And these problems are likely exacerbated for lower-income couples, who likely have less time or money to devote to the kind of quality time needed to meet today’s marriage expectations than their wealthier counterparts. But the research shows that lower-income couples still very much want the same things out of marriage as higher-income spouses.

It’s not hopeless, however. There are a few ways of improving marriage quality, none of which take huge amounts of time, which Finkel and his co-authors helpfully outline in their paper:

If you want to get nerdy about it, you guys can take on some writing exercises. The researchers cite a study that found couples who spent just 21 minutes a year writing about their conflicts through the eyes of an impartial third party saw improvements in their relationships over the following two years. It’s not going to magically turn a dissatisfying relationship into a blissfully happy one, but it’s a pretty simple way to give it a nudge.

Schedule regular “date nights.” (There’s a reason it’s a cliché.) It’s because scheduling time together really works to improve the relationship, the research suggests. Spending more fun hang-out times for just the pair of you will likely help increase the odds that you meet each other’s psychological needs.  

Seek at least some of that self-actualization stuff elsewhere. Find a hobby, join a group, call your friends — shift at least some of that personal-growth burden off of your relationship. “Doing so can bring the demands on the marriage into closer alignment with the available resources,” the authors write, “thereby reducing dissatisfaction from unmet expectations.”

It’s not impossible to have a successful marriage in this “self-expressive” era, Finkel said, but we’re only just starting to learn how to do it. (Incidentally, he’s currently writing a book on that very subject.) Finding a balance between sky-high expectations and the time people can realistically invest in their relationships seems like one way to start.

More from Science of Us:

Married People Are Happier People

What Happens When Rich People Marry Poor People

3 Ways Your Text Messages Change After You Get Married

Americans Now Slightly More Relaxed About Casual Sex That They Were in the ’90s

Why Men Always Think Women Are Flirting

The Case Against ‘Soul Mates’

Science of Us is a smart but playful window into the latest science on human behavior, with the goal of enlightening, entertaining, and providing useful information that can be applied to everyday life.

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A Healthy Body Often Equals a Healthy Brain

By Dennis Thompson
HealthDay Reporter

TUESDAY, June 30, 2015 (HealthDay News) — People who want to stay sharp as they age often turn to brain teasers, puzzles and games, figuring correctly that they’ll lose it if they don’t use it.

But a healthy body is also key to maintaining a healthy brain, and that’s something many people tend to overlook, experts say.

“We’re just now starting to get people to recognize that eating right and exercising and maintaining your health can play into the graceful aging of your brain,” said Dr. Mary Ann Bauman, an Oklahoma City physician and chair of the American Stroke Association advisory committee.

Healthy living tips make up more than half of the “10 Ways to Love Your Brain” recently released by the Alzheimer’s Association, as part of June’s Alzheimer’s & Brain Awareness Month.

An estimated 47 million people worldwide are living with dementia in 2015, and this number is projected to triple by 2050, according to the Alzheimer’s Association.

Medical science cannot stop the progression of either dementia or Alzheimer’s disease, but everyone can take steps to maintain their ability to think, problem solve and remember as they grow older, said Heather Snyder, director of medical and scientific operations for the Alzheimer’s Association.

“There’s no one specific thing that if you do this, you will reduce your risk,” Snyder said. “It’s really a balance of these top 10 ways to love your brain. By doing all these things in balance, you’re going to age as healthfully as you can.”

Maintaining the health of your heart and your circulatory system appears to be a key factor in protecting your mental capabilities, Bauman said.

Researchers now believe that micro-strokes — tiny decreases in blood flow to the brain — can add up and, over time, cause a person to suffer a loss of their faculties, she said.

By keeping the brain both healthy and active, a person can preserve what’s called their “brain reserve” — the ability of the brain to weather various insults, including aging, said Dr. Norman Relkin, a neurologist at Cornell University’s Weill Cornell Medical College in New York City and a board member of the American Federation of Aging Research.

“The more brain reserve a person brings to the table, the older they can get without showing signs and symptoms of memory loss,” Relkin said.

The Alzheimer’s Association tip sheet urges everyone to:

• Engage in regular physical activity. A number of studies have linked exercise to reduced risk of brain decline, Bauman said.
• Quit smoking. Smoking increases risk of brain decline, and quitting can reduce a smoker’s risk down to levels comparable to people who have never smoked, the association says.
• Treat conditions that can affect heart health. Chronic problems like obesity, high blood pressure, high cholesterol and diabetes take a toll on your brain as well as your heart, Bauman said.
• Get enough sleep. Studies have linked sleeplessness with problems in memory and thinking, the association says.
• Maintain your mental health. Depression, anxiety and stress can speed a person’s brain aging, if they are left untreated. “We know that stress hormones, when produced in excess, causes the brain to shrink more rapidly,” Relkin said.
• Protect your head. Brain injuries as mild as a concussion can increase risk of brain decline and dementia. Wear a seat belt, use a helmet when on a bike or playing contact sports, and try to avoid falling down.
• Eat a healthy low-fat diet that’s rich in fruits and vegetables. A good diet can help address nearly all chronic illnesses, and therefore will ultimately help your brain, Relkin said. “Diet clearly impacts not only our risk of developing cognitive [brain] disturbances, but also affects our longevity,” he said. “I think we’re going to see more and more in terms of dietary interventions that are going to impact the aging process.”

The remaining tips offered by the Alzheimer’s Association focus on keeping your brain busy and active, which also can help by forcing the brain to preserve and build up its neural connections, Relkin said.

These brain-centered tips from the Alzheimer’s Association include:

• Keep learning. Continuing education can help reduce risk of brain decline and dementia.
• Remain social. People who have an active social life have been shown to have more active and healthy brains, Relkin said.
• Challenge your brain. Do something that requires thought, whether that is solving a puzzle, creating a piece of art, building something for your home, or playing a game that forces you to think strategically.

“All these pieces of advice seem to bear out in the reduction of the development of dementia,” Relkin said. “We have a lot of knowledge about ways to prevent the deterioration of the brain due to aging, and they all appear to be beneficial in terms of preserving the health of the brain.”

More information

Visit the U.S. National Institutes of Health for more on brain health.

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‘Novice Driver’ Car Decals Don’t Cut Crash Rates: Study

MONDAY, June 29, 2015 (HealthDay News) — Adding decals to the license plates of drivers with learner permits doesn’t reduce their rate of crashes, a new study finds.

The experimental safety strategy was implemented in New Jersey in 2010 as part of its graduated driver-licensing policy for drivers under 21.

Red reflective decals were placed on the license plates of drivers with learner permits or intermediate licenses. The decals are intended to make other drivers and police aware that a novice driver is behind the wheel.

Using information compiled in New Jersey’s driver-licensing database and police-reported crash database, researchers estimated the monthly rate of incidents for every under-21 driver with a permit from January 2006 to June 2012.

After taking age, gender, gas price and the month into account, the researchers determined that the decal program did not alter crash rates among drivers with learner permits. Nor did it affect the rate of citations for violation of the state’s graduated driver-licensing policy.

Authors of the study, published online June 29 in Injury Prevention, included Dr. Allison Curry of the U.S. Center for Injury Research and Prevention.

The researchers theorized that drivers with learner permits already comply with passenger and night-time restrictions, and they said crash rates among these adult-supervised drivers are already low. As a result, they said, there is little room for improvement so the initiative didn’t appear to have a significant effect.

They noted, however, that using the decals could potentially boost compliance with traffic safety laws.

Several other states have or are considering similar decal provisions, the researchers said.

More information

The U.S. Centers for Disease Control and Prevention provides more information on motor vehicle safety.

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